Going Public on What is Private

Going Public on What is Private

Much of the health care Canadians receive today comes from private sources, yet the most heated debate in Canada revolves around public versus private health care.

“Most of us get most of our health care from private sector suppliers,” the paper points out. “Doctors, for example, and especially family physicians, are, in economic terms, small, for-profit businesspeople. They happen to earn most of their income by supplying services to the publicly funded health care system, but, for all we hear about doctors’ salaries, they’re not actually employed by it. They earn revenue by supplying individual services to individual consumers, out of their revenue they pay their costs of practice – labour, equipment, rent, electricity and all the rest – and what’s left they take home as income.”

The vast majority of doctors, dentists, opticians and optometrists, pharmacists, chiropractors, and purveyors of natural remedies work in the private sector, in the sense that they’re not salaried public sector employees.

Going Public on What is Privatealso looks at the terms for-profit and non-profit as they relate to physician and hospital services. It suggests the argument that Canadian hospitals are actually private non-profit institutions run by a board of directors is a fallacy.

The CHCCG Background Paper explains the reality of the situation in this country, “The Canadian experience is full of episodes of provincial departments of health closing or merging hospitals, and telling hospitals what services they may or may not supply. Hospital boards and hospital management have decision making authority only so long as the decisions they make are the decisions the provincial departments of health want them to make.”

It suggests the quality of hospital care won’t improve until hospital managers are allowed to manage.

The background paper also points out that there have been dramatic changes in technology since Canada’s Medicare act came into being. Yet Canada’s medicare system has not changed to reflect those innovations. Many of the procedures that then required hospitalization can now be performed in much less expensive settings, like stand alone specialty clinics, or even doctors’ offices. Opponents of greater private initiative on the supply side of care generally have no objection when the government decides to establish such clinics; it’s when a group of doctors see a need and, without waiting for government action, take steps to fill it that the red flags go up.

The paper suggests that much of the opposition is ideological. “A great many opponents of private supply initiatives firmly believe that doctors simply can’t be trusted. It’s about time that we decided whether that’s really a good basis for Canadian health care policy.”

Members of the CHCCG came together to provide a platform for bold, reasoned and practical plans for genuine reform of the health care system and to demonstrate that there is an emerging consensus among reform-minded observers about the direction that real reform must take. The CHCCG, coordinated by the Atlantic Institute for Market Studies (www.aims.ca/acedoc), one of Canada’s best-known public policy think tanks, includes medical practitioners, former health ministers, past presidents of the Canadian Medical Association and provincial medical and hospital associations, academics, and health care policy experts, all of whom are signatories to the group’s Statement of Principles.

Going Public on What is Privateis the first of a series of background papers prepared for the CHCCG, which are intended to contribute to that new debate. These papers do not represent official positions of the Consensus Group, and are not themselves consensus documents, but rather are intended to act as starting points for debate, some of which will occur on the Consensus Group’s website (www.consensusgroup.ca). The first few papers will deal with aspects of the “public” versus “private” debate, while later ones will consider other issues which were raised in the Consensus Group’s Statement of Principles.